Rivaroxaban Dosing Guidelines for Patients with Impaired Renal Function

Dosing Considerations

For patients with moderate renal impairment (CrCl 15-49 mL/min), the European Society of Cardiology recommends reducing the dose of rivaroxaban from 20 mg once daily to 15 mg once daily when treating venous thromboembolism (VTE) or atrial fibrillation 1
The American College of Cardiology recommends reducing the dose of rivaroxaban from 20 mg once daily to 15 mg once daily after the initial treatment phase for VTE treatment in patients with moderate renal impairment (CrCl 15-49 mL/min) 3
For patients with moderate renal impairment (CrCl 15-49 mL/min) and a high bleeding risk (HAS-BLED score ≥3), the European Heart Rhythm Association recommends a dose of 15 mg once daily 1

Approximately one-third of active rivaroxaban is cleared by the kidneys, and there is no accumulation of drug when CrCl is above 15 mL/min, but dose adjustment is still required for moderate impairment, as stated by the European Society of Gastroenterology 2
Regular assessment of renal function is recommended in patients on rivaroxaban, with renal function assessments 2-3 times per year for patients with moderate renal impairment (CrCl 30-49 mL/min), according to the European Society of Cardiology 1

For VTE treatment, the American College of Cardiology recommends an initial phase of 15 mg twice daily for 21 days, followed by a maintenance phase of 20 mg once daily (standard renal function) or 15 mg once daily (moderate renal impairment) 3, 4
For atrial fibrillation, the European Heart Rhythm Association recommends a standard dose of 20 mg once daily with food, and a reduced dose of 15 mg once daily for patients with moderate renal impairment (CrCl 30-49 mL/min) 1